Healthcare Provider Details

I. General information

NPI: 1699574574
Provider Name (Legal Business Name): LORETTA REEVE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 2ND AVE
CHARLESTON WV
25387-2514
US

IV. Provider business mailing address

PO BOX 20112
CHARLESTON WV
25362-1112
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-4663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: